Many of the state's psychiatric hospitals are in failing health

Fixing the System

Most of the 27 people now in one of the three programs offered by Gateway Farm have come from state or private psychiatric hospitals. According to Valerie Marsh, executive director for the state affiliate of the National Alliance for the Mentally Ill (NAMI), they've been shuffled from one institution to the next and passed through a porous mental-health system which is viewed poorly by many mental health advocates and has been under fire from the U.S. Justice Department and other federal mental-health agencies.

Mental-health advocates say conditions in public and private adult home facilities vary, but the day-to-day level of care that exists at homes like Forest Hill Manor far too often is typical.

On the day of a recent unannounced visit, the pungent smell of urine hangs in the hallways of Forest Hill Manor. Hidden from Forest Hill Avenue by a tall hedge of red-tip photinia, the two-story brick house with a large addition is home to 78 residents with chronic mental illness. Dr. Nazir Chaudhary, a Richmond psychiatrist who owns the privately run adult care facility, did not return repeated phone calls for comment.

Not a smile can be found anywhere. If not for the disturbing conditions inside, one would blame the residents' despondency on the heat. But nature is not to blame. The air-conditioning is broken, the water is turned off (nearby water lines are being worked on, but Forest Hill Manor staff say they weren't notified that water service would be affected), the ceiling is leaking, and trash cans with discarded rubber gloves, blood-stained gauze and used plastic tubing litter the hallways. In less than one hour's time a fire alarm sounds twice, numerous phone calls go unanswered, and an ambulance is called. Amid the confusion practically no one moves, save the smokers outside. And while the cost per resident for a shared room at this private facility is $775 a month, it is not viewed by mental-health advocates like Marsh as a choice alternative to hospitalization.

The estimated cost per person for a year of health care in a state hospital is between $95,000-$125,000. "Most people think the answer to deinstitutionalization is reinstitutionalization," says Marsh, "but not at $125,000 a pop." She contends that getting legislators to act is more than a struggle because "legislators don't want to create an entitlement and have to come up with resources."

However, the 1999 General Assembly overwhelmingly passed a bill for insurance parity, drafted by state Sen. Stephen H. Martin, ensuring that mental-health benefits be given treatment in coverage payouts equal to that for physical benefits. Virginia became the 20th state to pass such legislation. While Sen. Martin expresses concern about possible abuse of the legislation from those who don't really need it and the effect it could have on insurance premiums, he still feels the bill is an important measure in promoting care for the mentally ill. "The truth is, over the last 12 years, we've seen a decline in the number of patients, yet we have not closed any facilities, and for people in the community who need that care, it is costing more than it should. We need to streamline those institutions and make more effective use of them and put more resources into the community," says Martin. NAMI's Marsh says this is a step in the right direction but needs follow-through.

She says that for Virginia's mental-health system to improve, it must revamp its nine state-run mental hospitals for the 21st century.

Marsh doesn't support closing all psychiatric hospitals, but she says that many buildings are simply too old, operating costs are too high and staffing is too intensive. "These hospitals are like iron lungs, and we're dragging them into the 21st century."

Marsh believes, too, that in many cases, care given mental-health patients is appalling. "The Department of Justice has accused five of Virginia's nine hospitals of abusing and neglecting people. The governor and the General Assembly should be closing them. Virginia is at least 10 years behind the times on a lot of these issues."

Marsh advocates a mobile health-care system like that in New Hampshire, where all but one mental hospital has closed, and there are more residential alternatives such as Gateway.

"Nobody's paying attention to creating an infrastructure for new housing, housing resources and support services," Marsh says. "Gateway represents one kind of housing program that every community needs ... but there is no one size fits